Accidental Opioid Overdose in Children Increasing
Dawson W and Leavitt S. Pain Treatment Topics. November-December 2008 News/Research Update.December 22, 2008
New research suggests that the increased availability of prescription opioids may be contributing to a surge in accidental overdose deaths and injuries among children under the age of 6. Investigators used data from poison centers participating in the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System. Exposures in children younger than 6 years, involving buprenorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, and oxycodone (January 2003 to June 2006) were analyzed.
The study reported that 9179 toddlers and children were involved in incidents related to opioid access during the 3.5-year period, with exposure ranging from a pill taken from a child's mouth to actual ingestion. In these incidents, 8 children died, while 43 suffered life-threatening injuries or serious disabilities, and 214 required prolonged medical attention. Of 51 patients who experienced a major effect or death, only 35 were treated with naloxone and a beneficial response was documented in 34 of them. The implicated medications belonged primarily to parents, grandparents, and other adults.
[Commentary: In a media interview (MSNBC, October 20, 2008), Richard Dart of the Rocky Mountain Poison and Drug Center noted that prescription drugs have become a primary cause of child poisonings, second only to carbon monoxide poisoning. He believes that the actual number of overdoses may be more than twice as high as what was voluntarily reported to the Center. Dart further observed that about half of the accidental prescription opioid exposures occurred in "complicated" households, which he defined as those including many adults living together or household members with a history of drug use or child neglect. The rest occurred in so-called "competent" families.
These data underscore the fact that practitioners need to consider where and how the opioid analgesics they prescribe will be used. They also need to remember to use naloxone promptly in cases of suspected opioid overdose, but judiciously.
Patients need to be educated not only on the safe use of these agents for themselves, but how to safeguard the medications from misuse, whether intentional or accidental, by other members of their households (including pets). They also need to understand how to recognize early signs of overdose and the importance of prompt action, including how naloxone serves as an effective antidote. –– SBL.]
Reference: Bailey JE, Campagna E, Dart RC, the RADARS System Poison Center Investigators. The Underrecognized Toll of Prescription Opioid Abuse on Young Children. Ann Emergency Med. Early online publication, DOI: 10.1016/j.annemergmed.2008.07.015.
